Healthcare Provider Details

I. General information

NPI: 1043021165
Provider Name (Legal Business Name): KEITH MICHAEL HUFFMAN LCMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2025
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6885 CLIFFDALE RD STE 202
FAYETTEVILLE NC
28314-2834
US

IV. Provider business mailing address

701 DANDRIDGE DR
FAYETTEVILLE NC
28303-2000
US

V. Phone/Fax

Practice location:
  • Phone: 910-339-0400
  • Fax: 910-339-0396
Mailing address:
  • Phone: 205-657-8223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number20860
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: